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193]

Original Article

Effects of continued psychological care

toward brain tumor patients and their
family members’ negative emotions
ABSTRACT Ning Xiao1,2,
Purpose: Numerous studies have confirmed that brain tumor patients and their family members frequently exhibit negative emotional Dan Zhu2,
reactions, such as anxiety and depression, during diagnosis and treatment of the disease. Family members experience increasing Shuiyuan Xiao1
pressure as the year of survival of patient progress. The aim of this study was to investigate the effects of the continued psychological
Department of
1 
care (CPC) toward the brain tumor patients and their family members’ emotions. Social Medicine and
Subjects and Methods: The asynchronous clinical control trial was performed, and 162 brain tumor patients and their family Health Management,
members were divided into the control group and the intervention group. The control group was only performed the telephone School of Public
Health, Central South
follow‑up toward the patients. Beside this way, the intervention group was performed the CPC toward the patients and their family
University, Changsha
member. The self‑rating anxiety scale (SAS) and the self‑rating depression scale (SDS) were used to measure the negative emotions 410078, 2Department
of the patients and their family members, and the patients’ treatment compliance and the incidence of seizures were compared. of Nursing, PLA 169
Hospital, Hengyang
Results: The SAS and SDS scores of the intervention group on the 14 days, 28 days and 3 months of the CPC were significantly
421002, Hunan
lower than the control group (P < 0.05); the SAS and SDS scores of the intervention group after the intervention were significantly Province, China
lower than those at the discharging (P < 0.05), the treatment compliance of the intervention group was significantly higher than the
control group (P < 0.05), and the seizure incidence of the intervention group was significantly lower than the control group (P < 0.05). For correspondence:
Dr. Shuiyuan Xiao,
Conclusion: The CPC could effectively reduce the anxiety and depression among the brain tumor patients and their family members. School of Public
Health, Central South
University, Changsha
KEY WORDS: Brain tumor, continued care, continued psychological care, patients, patient’s family members 410078, Hunan
Province, China.
E‑mail: shuiyuanxiao
@126.com
INTRODUCTION however, patient needs are frequently difficult to
fulfill. Continued care involves using information
The survival rate of the brain tumor patients tools, such as telephones, letters, e‑mails, and
has improved during the last 30 years; according personal visits from health care providers,
to statistics from 1995 to 2001, the survival among others. This process can effectively
years of level I/II cancer patients (World Health improve the quality of life of patients after
Organization Classification of Brain Tumors) is they are discharged from the hospital. Focused
2 years to 10 years, whereas that of level III/IV interaction can be established between health
cancer patients reaches 1 year.[1] Family members care providers and patients, as well as their
of brain tumor patients act as caregivers not family members, and thus patient health is
only when the patient is in the hospital, but
promoted and maintained.[3] Psychological care
also after the patient is discharged. Thus, family
is a nursing process that is guided by psychology
members experience increasing pressure as the
theories and is based on good interpersonal
year of survival of patient progress. Numerous
relationships. In this process, nurses interact
studies have confirmed that brain tumor patients Access this article online
and communicate with patients, thus influencing
and their family members frequently exhibit Website: www.cancerjournal.net
negative emotional reactions, such as anxiety DOI: 10.4103/0973-1482.181184
This is an open access journal, and articles are distributed under the terms of the
and depression, during diagnosis and treatment Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which PMID: ***
of the disease.[2] Most patients and their family allows others to remix, tweak, and build upon the work non-commercially, as long as Quick Response Code:
appropriate credit is given and the new creations are licensed under the identical terms.
members wish to avail of professional care after
the patient is discharged from the hospital; For reprints contact: reprints@medknow.com

Cite this article as: Xiao N, Zhu D, Xiao S. Effects of continued psychological care toward brain tumor patients and their
family members’ negative emotions. J Can Res Ther 2018;14:S202-7.

S202 © 2016 Journal of Cancer Research and Therapeutics | Published by Wolters Kluwer - Medknow
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Xiao, et al.: Effects of continued psychological care toward the brain tumor patients
and changing their psychological state and behavior. Such
process provides the best effect in medical care. In the
present research, continued psychological care (CPC) was
provided to 162 brain tumor patients and their family
members. The results revealed that CPC has an important
role in relieving the negative emotions of patients and their
family members.
SUBJECTS AND METHODS
Subjects
Brain tumor patients, who were discharged from a particular
3A hospital from October 2011 to September 2013, as well
as their family members, were selected as subjects for the
study. The inclusion criteria were as follows: (1) The patients
and their family members were all >18 years old. (2) The
patients and their family members had an educational
level higher than that of primary education. They should
be capable of oral and written communication, and should
agree to participate in the study. (3) Radiologic examination
had revealed the presence of occupying lesions, and brain
surgeons had already performed craniotomy. (4) The patients
and their family members should have no previous history
of mental illness and no serious physical illness in other
organ systems during the start of the study. A total of 162
brain tumor patients discharged from the hospital as well as
their family members were included in the study (patient:
Family member ratio = 1:1). The family members selected
for the study were either the parents, spouse or children of
the patient. The spouse was the first choice, followed by the
children, and then, the parents. Moreover, the selected family
member should be the primary caregiver of the patient. An
asynchronous clinical trial was conducted. Patients discharged
from October 2011 to September 2012, as well as their family
members were designated as the control group. A total of
92 brain tumor patients were discharged from the hospital
during that period, and 84 patients with 84 family members
satisfied the inclusion criteria. The patients discharged from
October 2012 to September 2013, as well as their family
members were assigned as the intervention group. A total of
89 brain tumor patients were discharged from the hospital
during that period, and 78 patients with 78 family members
satisfied the inclusion criteria. This study was conducted
in accordance with the Declaration of Helsinki. This study
was conducted with approval from the Ethics Committee
of  Central South University. Written informed consent was
obtained from all patients and their family members.
Developing a Health Monitoring Handbook for Brain Tumor
Patients
The handbook included health guidelines for brain tumor
patients. A table was used for recording the daily medication,
exercise activities, symptoms, seizure incidence, and
reconsultation schedule of the patient. Those who satisfy the
requirements of the health guidelines were checked, whereas
those who did not were crossed.
Journal of Cancer Research and Therapeutics - Volume 14 - Supplement Issue 1 - 2018
Developing a continued care training program for brain
tumor patients
The training included providing information on the brain
tumor, as well as discussing the contents and requirements of
continued care, health guidelines, applications of the Health
Monitoring Handbook for Brain Tumor Patients, professional
ethics, service concepts, etiquette training, communication
skills, and psychology‑related knowledge.
Establishing the continued care team
The team consisted of four senior nurses with comprehensive
expertise and effective communication skills. Registration
for the CPC team was voluntary, and the registrants should
pass the examination for brain tumor CPC training. Those
who passed the examination were then assigned to provide
one‑on‑one CPC to brain tumor patients as their next
assignment.
Intervention
When the patients in the control group were discharged,
the nurses in charge explained the health guidelines to the
patients and their family members. The nurses also guided
them in filling in the Health Monitoring Handbook for Brain
Tumor Patients. The contact information of the patients was
recorded. Routine telephone interviews on the 7th, 14th, and
28th day after discharge were conducted. Monthly follow‑ups
were performed for the first 3 months, and then, twice a year
thereafter. During routine telephone interviews, the general
health condition, symptoms, medications, seizure incidence,
and rehabilitation training, etc., of the patients were asked.
The patients were also given health education and guidance
in rehabilitation. Finally, they were reminded of their next
consultation schedule.
On the discharge of patients in the intervention group, a
designated CPC member communicated with the patients and
their family members, and informed them of the objective,
type, period, and contents of CPC. The CPC protocol was then
signed voluntarily. The team members first provided health
guidelines to the patients, directing them, and their family
members to fill in the Health Monitoring Handbook for
Brain Tumor Patients. Then, the team members recorded the
contact information of the patients and their family members.
CPC members conducted routine telephone interviews with
the patients and their family members on the 6th, 13th, and
27th day after discharge. Monthly follow‑ups were performed
for the first 3 months after discharge, and then, semi‑annually
thereafter. The general health condition, subjective symptoms,
medications, seizure incidence, and rehabilitation training of
the patients were determined, as well as the psychological
feeling of the patients and their family members. After
the telephone interviews, individualized care plans were
developed according to conditions of the patients and their
family members. Moreover, home visits were made on the
2nd day after the telephone interviews to provide psychological
support and counseling.
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Xiao, et al.: Effects of continued psychological care toward the brain tumor patients
General information questionnaire
The questionnaire primarily included the gender, age,
educational level, marital status, and medical expenses of the
patients and their family members.
Self‑rating anxiety scale and self‑rating depression scale
Each scale has 20 items that are divided into four‑grade scores
to assess the subjective feelings of anxiety and depression of
patients and their family members. The evaluation criteria are
as follows. A self‑rating anxiety scale (SAS) standard score >50
points indicates anxiety symptoms, whereas a score >62
points indicates severe anxiety symptoms.[4] Meanwhile, a
self‑rating depression scale (SDS) standard score >53 points
indicates depression symptoms, whereas a score >70 points
indicates severe depression symptoms.[4] The evaluation was
performed on the patients and their family members after
the 14th and 28th day, and 3rd month telephone interviews for
the control group. For the intervention group, evaluation was
performed on the patients and their family members after the
14th and 28th day, and 3rd month home visits.
Treatment compliance evaluation form
A year after the patients in the two groups were discharged,
data, reconsultation data, and follow‑up data of the
patients (i.e., the Health Monitoring Handbook for Brain Tumor
Patients) were collected and analyzed. The self‑developed
treatment compliance and seizure incidence evaluation table
were used to compare the situations of the patients in the two
groups. The table included three aspects, with a total of 12
items. The total score was nine points: 4 points for treatment
compliance, 4 points for seizure incidence, and 1 point for
regular reconsultation compliance. The detailed information
is provided in Table 1.
Statistical analysis
Microsoft Excel and  SPSS 13.0 (SPSS Inc., Chicago, USA) statistical
software were used for data processing. The statistical methods
used included descriptive statistics, U test, and χ2 test. P <0.05
was considered as significantly different.
RESULTS
General information
No significant difference was found regarding gender, age,
educational level, and marital status between the two
groups [Table 2], (P > 0.05).
Table 1: Point assignment information of medication compliance and seizure situation evaluation table toward brain tumor
patients
Item 4 points 3 points
Medication Regular medication Missed medication
compliance weekly once a week
Seizure No occurrence Occurred once
situation weekly a week
Reconsultation
compliance
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Comparing the self‑rating anxiety scale and self‑rating
depression scale scores of patients before and after
continued psychological care implementation
No significant difference in SAS and SDS scores between the
two groups (P > 0.05) was observed on discharge. On the
14th day, 28th day, and 3rd month of CPC implementation, the
SAS and SDS scores of the intervention group were significantly
lower than those on discharge (P < 0.05). The SAS and SDS
scores of the intervention group were also significantly lower
than those of the control group (P < 0.05). On the 14th day,
28th day, and 3rd month, the SAS and SDS scores of the control
group exhibited no significant difference with those on
discharge [Table 3], (P > 0.05).
Comparing the self‑rating anxiety scale and self‑rating
depression scale scores of the family members of
patients before and after continued psychological care
implementation
No significant difference in SAS and SDS scores was
found between the two groups of family members on
discharge (P > 0.05). On the 14th day, 28th day, and 3rd month
after CPC implementation, the SAS and SDS scores of the
intervention group were significantly lower than those on
discharge (P < 0.05). The SAS and SDS scores of the intervention
group were also significantly lower than those of the control
group (P < 0.05). On the 14th day, 28th day, and 3rd month, the
SAS and SDS scores of the control group exhibited no significant
difference with those on discharge [Table 4], (P > 0.05).
Comparing treatment compliance and seizure incidence
of patients before and after continued psychological care
implementation
After CPC implementation, the scores for treatment compliance,
seizure incidence, and regular reconsultation compliance of the
intervention group were significantly higher than those of the
control group [Table 5], (P < 0.05).
DISCUSSION
Continued care was introduced in the experimental study of
the Pennsylvania School of Nursing in 1998.[5] The philosophy
of continued care was proposed by Brooten et al. of the
University of Pennsylvania in 2002; it refers to nursing care
provided during the transfer from hospital to home.[6] The
American Geriatrics Society defined continued care as “care
that ensures that the patient will obtain different levels of
2 points 1 point 0 point
Missed medication Missed medication Missed medication
twice a week thrice a week more than thrice a week
Occurred twice Occurred thrice Occurred more than
a week a week thrice a week
Reconsulted according Did not reconsult
to the request regularly
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Xiao, et al.: Effects of continued psychological care toward the brain tumor patients

Table 2: General information of the brain tumor patients and their family members n (%)
Item Patient Family members
Control group Intervention Control group Intervention
(n=84) group (n=78) (n=84) group (n=78)
Gender
Male 41 (48.8) 42 (53.8) 25 (29.8) 22 (28.2)
Female 43 (51.2) 36 (46.2) 59 (70.2) 56 (71.8)
Age (years)
18-30 16 (19.0) 14 (17.9) 47 (56.0) 44 (56.4)
31-50 23 (27.4) 28 (35.9) 29 (34.5) 28 (35.9)
>50 45 (53.6) 36 (46.2) 8 (9.5) 6 (7.7)
Educational level
Junior school or below 21 (25) 23 (29.5) 22 (26.2) 14 (17.9)
Senior school and below university 36 (42.9) 32 (41.0) 33 (39.3) 30 (38.5)
Bachelor or above 27 (32.1) 23 (29.5) 29 (34.5) 34 (43.6)
Marital status
Married 49 (58.3) 47 (60.3) 51 (60.7) 53 (67.9)
Single or divorced 35 (41.7) 31 (39.7) 33 (39.3) 25 (32.1)
Relationship with the patient
Parents 21 (25) 19 (24.4) 21 (25) 19 (24.4)
Spouse 39 (46.4) 34 (43.6) 39 (46.4) 34 (43.6)
Children 24 (28.6) 25 (32.0) 24 (28.6) 25 (32.0)
Payment method of medical costs
At public expense 8 (9.5) 7 (9.0) 8 (9.5) 7 (9.0)
Medical insurance 66 (78.6) 65 (83.3) 66 (78.6) 65 (83.3)
At self‑expense 10 (11.9) 6 (7.7) 10 (11.9) 6 (7.7)

Table 3: Self‑rating anxiety scale and self‑rating depression scale scores of the two groups’ patients before and after the
continued psychological care implementation
Group SAS SDS
At 14 days 28 days 3 months At discharging 14 days 28 days 3 months
discharging later later later later later later
Intervention group (n=84) 47.02±5.46 41.17±5.03 34.02±4.31 26.13±3.12 54.25±5.67 47.48±5.14 38.26±4.67 29.23±3.13
Control group (n=78) 46.91±5.51 45.47±5.14 43.98±4.97 40.26±4.32 54.79±5.73 52.84±5.28 49.89±4.68 45.03±4.13
U 1.34 2.96 5.91 7.92 1.57 3.47 7.48 8.39
P >0.05 <0.05 <0.05 <0.05 >0.05 <0.05 <0.05 <0.05
SAS=Self‑rating anxiety scale, SDS=Self‑rating depression scale

Table 4: Self‑rating anxiety scale and self‑rating depression scale scores of the two groups’ family members before and after
continued psychological care implementation
Group SAS SDS
At discharging 14 days 28 days 3 months At discharging 14 days 28 days 3 months
later later later later later later
Intervention group (n=84) 36.54±8.12 30.98±7.59 26.54±6.23 19.53±4.96 35.26±8.68 29.01±7.85 20.58±5.96 12.41±4.85
Control group (n=78) 37.01±8.24 35.64±8.12 32.53±7.94 29.15±8.15 35.19±8.74 35.81±8.36 33.65±8.15 30.81±7.83
U 1.68 3.96 4.14 5.17 0.89 4.15 5.41 6.23
P >0.05 <0.05 <0.05 <0.05 >0.05 <0.05 <0.05 <0.05
SAS=Self‑rating anxiety scale, SDS=Self‑rating depression scale

Table 5: Scores of treatment compliance and seizure hospital) through a series of designed actions.” Continued care
incidence of the two groups generally refers to the continuity of care from hospital to home,
Group Medication Regular reconsultation Seizure including the discharge plan developed by the hospital, the
compliance compliance incidence transfer of treatment, and continuous follow‑up and guidance
Intervention 3.53±0.39 0.72±0.45 3.48±0.62
group (n=84)
after the patient returned to his/her home, or community.[7]
Control 3.13±0.75 0.37±0.48 2.88±0.80 Other scholars described the meaning of continuity from three
group (n=78) different dimensions. The first dimension is the continuity of
U 3.129 4.075 4.565 the information of the patient, which ensures the accuracy of
P <0.05 <0.05 <0.05
information during treatment and transfer among different
medical institutes. The second dimension is the continuity
collaborative and continuous care from different health‑care of health care services throughout the entire health service
facilities (such as from hospital to home) and from the same system. That is, patients should always be ensured of
health‑care facility (such as different departments of the continuous health care. The third dimension is the continuity

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Xiao, et al.: Effects of continued psychological care toward the brain tumor patients
of doctor–nurse–patient relationship. That is, the continuity
of the loyal and trusting relationship among doctors, nurses,
and patients when the latter receive services provided by
different health‑care providers.[8]
In the past, the discharge of a patient from a hospital typically
meant the end of the relationship between the patient and the
hospital. The patient then returns to the hospital for related
rehabilitation information, and satisfying the requests of
the patient is sometimes difficult. Studies have shown that
although the majority of health problems of patients can be
solved during hospitalization, many patients still experience
various degrees of health problems at home. Thus, continued
treatment after discharge is important. Patients and their
family members are becoming increasingly demanding with
regard to knowledge on self‑conditioning, disease observation,
and health care after discharge; therefore, an increasing trend
in continued services at home was observed.[9] Thus, patients
still have a high demand for health care after discharge, and
consequently, most patients still require continued care after
discharge. At present, continued care is applied in managing
diabetes, chronic kidney diseases, breast cancer, colorectal
cancer, and other diseases; this form of health care has
achieved good results.[10‑12] CPC is a type of continued care
that including psychological support and counseling. In
current societies, the status of psychological and psychiatric
problems has gradually improved and has received increasing
attention in our country.[13] After discharge, patients and their
family members will encounter psychological problems. CPC
can provide them with specific guidance based on the illness
recovery situation of the patients. CPC also addresses concerns
during the rehabilitation process and provides psychological
support and counseling to patients and their family members.
Thus, patients and their family members will be confident
while performing rehabilitation training, and thus, healing of
the disease is promoted. In this research, CPC was provided to
brain tumor patients and their families after discharge. CPC
effectively reduced the negative emotions of the patients and
their family members, improved the treatment compliance of
the patients, and reduced the incidence of seizures. Therefore,
CPC is feasible and should be implemented.
Tumor is a severely negative life event. Patients with tumors
experience severe anxiety and depression reactions, thereby
affecting the prognosis and outcome of the disease as well
as reducing the quality of life of the patient. [13] Modern
psychosomatic medicine has proven that physical illnesses
can lead to emotional disorders, such as anxiety, sadness, and
fear.[14] These emotional disorders can aggravate the physical
disease through reactions in the brain cortex center. Tension
stimulates the growth and development of tumor, and an
adverse psychological status aggravates the adverse reactions
of the treatment, which significantly affects the quality of
life of cancer patients. In this study, trained and qualified
nurses formed the CPC team. They performed one‑on‑one
S206 Journal of Cancer Research and Therapeutics - Volume 14 - Supplement Issue 1 - 2018
continued care for patients and their family members. The
basic information of the patients and their family members
was obtained through telephone interviews. Appropriate
nursing interventions were then developed, and home visits
were made to observe the psychological status of the patients
and their family members. CPC members comprehensively
understood the needs of the patients and their family members
and specifically explained disease‑related knowledge. They
also provided psychological support and counseling. The
results of our study showed that no significant difference
was found in the SAS and SDS scores between the two
groups on discharge (P > 0.05). On the 14th day, 28th day, and
3rd month of CPC implementation, the SAS and SDS scores of
the intervention group were significantly lower than those on
discharge (P < 0.05). The SAS and SDS scores of the intervention
group were also significantly lower than those of the control
group (P < 0.05). On the 14th day, 28th day, and 3rd month,
the SAS and SDS scores of the control group exhibited no
significant difference ith those on discharge (P > 0.05). After
CPC implementation, the scores for treatment compliance,
seizure incidence, and regular reconsultation compliance
of the intervention group were significantly higher than
those of the control group (P < 0.05). This finding indicates
that CPC implementation enabled the patients and their
family members to understand and accept the situation of
the patients, to not feel afraid of the disease, and to have
confidence on its prognosis. The results showed that anxiety
and depression were effectively reduced among the patients
and their family members. Treatment and reconsultation
compliance were significantly improved, and seizure incidence
was also effectively controlled. These improvements will be
conducive to the prognosis of the disease. Our results are
consistent with those of previous studies[15‑17] thus indicating
the feasibility of our study. CPC implementation can relieve
anxiety and depression in both brain tumor patients and their
family members.
Continued care, which is based on theories of human care
and holistic nursing, can satisfy the needs of discharged
patients. This procedure expands medical care services beyond
hospitalization, including treatment, and rehabilitation after
discharge. By adopting appropriate strategies, research on and
practice of continued care can improve information exchange
and transmission, strengthen follow‑ups, and promote an
effective interface among health‑care services.[18] At present,
continued care is regarded as a priority outcome of health‑care
services, and the process has been studied only at a limited
level from the perspective of patients.[19] Furthermore, effective
measures for enlisting family members in care planning remain
lacking. Therefore, the roles of the family members of patients
in the care process should be further extended and defined.[18]
CPC is part of continued care but is rarely studied locally and
abroad. Further studies should be conducted to make this
case mode a part of hospital work and to institutionalize and
standardize continued care for effective implementation.
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Xiao, et al.: Effects of continued psychological care toward the brain tumor patients
CONCLUSION
CPC can effectively reduce anxiety and depression among
brain tumor patients and their family members. CPC should
be further studied to provide an evidence‑based foundation
to implement continued care.
Financial support and sponsorship
Nil
Conflicts of interest
There are no conflicts of interest.
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